Evidence-Based Medicine for Nonsurgical Facial Rejuvenation.

Area of Science:

• Aesthetic Medicine
• Dermatology
• Evidence-Based Practice

Background:

• Nonsurgical facial rejuvenation treatments have gained popularity over the last 20 years.
• There is a significant lack of clinical practice guidelines and evidence-based recommendations for these procedures.
• High-level research is crucial for establishing safety and efficacy standards.

Purpose of the Study:

• To assess the availability of high-level research for various nonsurgical facial rejuvenation methods.
• To evaluate the evidence supporting the safety and efficacy of popular rejuvenation techniques.
• To identify gaps in research that hinder the development of clinical practice guidelines.

Main Methods:

• Utilized the Oxford Centre for Evidence-Based Medicine criteria to evaluate research quality.
• Reviewed randomized controlled trials (RCTs) and other high-level studies for different rejuvenation modalities.
• Assessed the evidence base for botulinum toxin, injectable fillers, deoxycholic acid, chemical peels, laser resurfacing, energy-based devices, microneedling, and platelet-rich plasma.

Main Results:

• Botulinum toxin injections are the most extensively studied, with numerous RCTs supporting their safety and efficacy.
• Injectable fillers have limited high-level evidence, with studies often small, noncomparative, and highlighting complications.
• Deoxycholic acid is well-researched for submental fat but not other facial areas. Other modalities like chemical peels, lasers, and microneedling show variability in protocols and outcomes, lacking extended follow-up in RCTs.

Conclusions:

• Botulinum toxin is the best-supported nonsurgical facial rejuvenation treatment based on current high-level evidence.
• Significant research gaps exist for injectable fillers and other popular treatments, preventing robust clinical practice guidelines.
• Further high-quality, comparative studies with extended follow-up are needed for most nonsurgical facial rejuvenation methods to ensure patient safety and optimize outcomes.